Case Management Manager

Employer paid Medical, Dental & Vision premiums!

Wage Range: $136100.42 to 223069.93

Definition of Position: 

The Case Management Manager serves as the Team Lead for the Case Management Department, directing the daily functions of the Case Management staff, including providing input into job evaluations and work assignments. This position is responsible for ensuring that all functions of Case Management, including communication with third-party payers and financial services, occur regularly and are documented appropriately. As the second layer of review, this role addresses discrepancies in levels of care identified by Case Management staff, escalating unresolved issues to the CNO as needed. The Case Management Manager will oversee the case management department, ensuring effective patient care coordination, resource utilization, and discharge planning. They lead a team of case managers, collaborate with medical staff, insurance providers, and community resources to optimize patient outcomes while controlling costs.

Essential Job Functions:

• Reviews patient charts according to pre-determined criteria.
• Prepares data reports based on pre-determined parameters.
• Assists in coordinating communication with Nursing Departments regarding data collection and Case Management issues.
• Collects data systematically and enters it into the data management software system.
• Supports the hospital's mission, goals, objectives, policies, and procedures, adhering to all management standards.
• Facilitates the development of educational programs to support department operations.
• Responsible for the sound fiscal management of the department, ensuring sound fiscal practices, including the development, implementation, and participation in the annual budgeting cycle (including operational and capital equipment).
• Maintains knowledge of current trends in Case Management and healthcare administration.
• Supervise and mentor the clinical case management team, including registered nurses, social workers, and other healthcare professionals.
• Develop and implement case management policies, procedures, and standards in accordance with healthcare regulations and hospital goals.
• Collaborate with physicians, nurses, and multidisciplinary teams to develop comprehensive patient care plans.
• Ensure timely and appropriate discharge planning, including placement in post-acute care facilities or community resources.
• Monitor departmental performance metrics and implement quality improvement initiatives.
• Conduct regular staff meetings, evaluations, and training to maintain high standards of care and compliance.
• Liaise with insurance providers and external agencies to facilitate authorizations and manage denials or appeals.
• Stay updated on healthcare laws, coding requirements, and industry best practices.
• Manage department budgets and resources effectively.
• Other duties as assigned.

Qualifications:

Education:

Required: 

• • Graduation from an accredited school of professional nursing with Bachelor of Science in Nursing (BSN) or a master’s degree in social work (MSW) or related field.
  • Evidence of continuing education relevant to nurse management, social work, and/or the specific area of case management.

Desired: 

• • Master of Science in Nursing (MSN) or master’s degree in social work (MSW).
  • Certification in Case Management or a related specialty area.

Licenses/ certifications/ registrations:

Required:

• •  Current and valid RN License in the state of Oregon OR Preferred LCSW/LMSW in the state of Oregon (if an MSW is held).
  • Case Management/CPHQ Certification preferred, required within 2 years of hire.

Experience:

Required:

• • Minimum of 2 years of experience in case management within a hospital or healthcare setting.
  • Previous supervisory experience.
  • Understanding medical records procedures and general coding/case management information.

Other:

• Bilingual (English/Spanish) preferred.
• Demonstrated ability to work with culturally diverse populations.
• Strong understanding of patient care processes, insurance policies, and regulatory requirements.
• Excellent communication, organizational, and problem-solving skills.
• Demonstrated leadership and team management skills.

Physical Requirements:

The physical and sensory functions described below are essential to the successful performance of this position. In accordance with the Americans with Disabilities Act (ADA), reasonable accommodations may be made to enable qualified individuals with disabilities to perform these essential functions. The position requires sufficient auditory ability to detect and respond to various sounds, including patient alarms and verbal communication. Clear and effective verbal communication is essential, as is the ability to interact with patients, families, and healthcare team members. Visual acuity is necessary for observing patient conditions, reading documentation and monitors, and distinguishing colors for clinical purposes, such as identifying medications or safety indicators. Tactile perception is also important for assessing physical characteristics such as temperature, size, shape, or texture during patient care. Motor coordination is required for reaching, grasping, handling, and performing fine motor tasks necessary for the use of medical equipment and procedures. The position also involves occasional stooping, kneeling, crouching, or crawling when assisting patients or accessing equipment. Walking and standing are typically continuous throughout the shift. The role requires the ability to lift up to 50 pounds independently and involves frequent pushing, pulling, carrying, or repositioning of objects or patients weighing up to 25 pounds. There may also be occasional lifting or transferring of individuals weighing over 100 pounds, with the expectation that appropriate lifting techniques, mechanical aids, or team assistance will be used to ensure safety. May need to sit for long periods.

Working Conditions:

This position is performed primarily in an indoor healthcare environment, such as a hospital, clinic, or long-term care facility. While the work setting is protected from outdoor weather conditions, it may be subject to variable indoor temperatures. The role involves frequent exposure to infectious and contagious diseases, hazardous materials, and medical equipment, with the expectation that all staff follow appropriate safety protocols and utilize personal protective equipment (PPE) as required.

The healthcare environment can be fast-paced and unpredictable, requiring the ability to respond quickly to changing circumstances, including high-pressure or emergency situations. The work setting also involves multiple simultaneous demands and varying levels of noise due to medical equipment, staff activity, and patient needs.